Many health systems around the world are introducing new care models which claim to replace expensive acute inpatient care with more primary and community-based services. This paper by Milliman consultants examines the primary care redesign of seven US practices over the course of three years, including their reported utilisation and savings achievements.
The cost of hospitalization for acute coronary syndrome (ACS) is expensive and continues to rise. In terms of direct medical expenditures, ACS costs Americans more than $150 billion annually, with approximately 60% to 75% of these costs related to hospital admission and readmission. No prior studies have addressed the cost of inpatient mortality during an ACS admission. This article, co-authored by Milliman’s Jill Van Den Bos and Travis Gray, compares ACS-related length of stay, total admission cost, and total admission cost by day of discharge/death for patients who died during an inpatient admission with a matched cohort discharged alive following an ACS-related inpatient stay.
This article was published by PubMed.
The Internal Revenue Service (IRS) has issued Notice 2014-69, stating that an employer-sponsored health plan cannot be considered to offer “minimum value” (MV) coverage unless it provides “substantial” coverage for inpatient hospitalization or physician services (or both). Accordingly, an employer will not be allowed to rely on the MV calculator or on an actuarial certification or valuation to establish MV of a plan that does not cover these services. The IRS coordinated the substance of the notice with the U.S. Departments of Labor (DOL) and Health and Human Services (HHS).
The agencies intend to propose regulations on this prohibition soon, with an expectation of issuing a final rule by the end of March 2015, and applying it then rather than delaying the applicability to the end of 2015 or the end of the 2015 plan year.
However, as of November 4, 2014—the date the IRS released the notice—employers may not adopt new MV plans that do not cover inpatient hospitalization or physician services. If an employer has entered into a binding written commitment to adopt, or has already begun enrolling employees in, a plan without these services for a plan year that begins before March 1, 2015, it will not be penalized. A large employer that fails to offer its full-time employees an affordable health plan that offers MV is subject to a penalty of $3,000 (indexed by the premium adjustment percentage) per full-time employee who receives premium tax credits by purchasing coverage through the health insurance exchanges.
An employer that offers employees a plan without the required services (including a plan before November 4, 2014) must not state or imply that the offer precludes an employee from obtaining a premium tax credit in any disclosure materials. Furthermore, an employer, in a timely manner, must correct any prior disclosures that indicated the plan met MV or precluded employees from receiving a premium tax credit. However, an employer that offers an employee another plan with inpatient hospital and physician services that is affordable and provides MV is permitted to advise employees that the offer will or may preclude them from obtaining premium tax credits.
For more information about the IRS’s notice restricting plans that exclude inpatient hospitalization and/or physician services, please contact your Milliman consultant.